Shingles (Herpes Zoster) (cont.)

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

What is the contagious period for shingles?

The virus that causes shingles, the varicella zoster virus, can be transmitted from person to person by direct contact with the fluid from the active blistering rash. It cannot be transmitted by coughing or sneezing, and it is not contagious before the blisters appear. Once the shingles rash has dried and developed crusting, it is not considered to be contagious.

There are a few important points to consider when discussing the varicella zoster virus and transmissibility. If an individual who has never had chickenpox or the chickenpox vaccine comes in direct contact with the fluid from the shingles rash, they may go on to develop chickenpox, but they will not immediately develop shingles. It is possible, however, for them to develop shingles later in life, just as it is with others who have previously been exposed to the virus and developed chickenpox. Also, if you have previously been exposed to the varicella zoster virus and you have had chickenpox, you will not contract the virus from others with shingles.

What are shingles symptoms and signs?

Shingles usually starts with burning, tingling, itching, or stinging in the region where the rash will ultimately develop. Sometimes, this pain can be severe and individuals may complain of extremely sensitive skin. This discomfort typically occurs a few days before the rash develops. In rare instances, the characteristic shingles rash will not appear (a condition called zoster sine herpete).

Often, individuals may also experience other associated symptoms such as

A few days after the skin discomfort begins (or rarely, several weeks afterward), the characteristic rash of shingles will appear. It typically begins as clusters of small red patches that eventually develop into small blisters. These fluid-filled blisters eventually break open, and the small sores begin to slowly dry and crust over. The crusts usually fall off after several weeks, and the shingles rash typically clears up after approximately four weeks. Though uncommon, in cases of a severe rash, skin discoloration or scarring of the skin is possible.

The location of the shingles rash can vary. Though shingles can appear almost anywhere on the body, it most commonly affects the torso and the face (including the eyes, ears, and mouth). It is often present in the area of the ribcage or the waist. This characteristic rash is in a stripe or band-like pattern that affects only one side of the body (the right or the left), and it usually does not cross over the midline. In some cases, the rash can affect adjacent dermatomes, and rarely it can affect three or more dermatomes (a condition termed disseminated zoster). Disseminated zoster generally occurs only in individuals with a compromised immune system.